Provider Demographics
NPI:1275791964
Name:GREENBAUM, REINA S (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:REINA
Middle Name:S
Last Name:GREENBAUM
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 WESTERN HWY
Mailing Address - Street 2:
Mailing Address - City:TAPPAN
Mailing Address - State:NY
Mailing Address - Zip Code:10983-1311
Mailing Address - Country:US
Mailing Address - Phone:845-359-0010
Mailing Address - Fax:
Practice Address - Street 1:422 WESTERN HWY
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983-1311
Practice Address - Country:US
Practice Address - Phone:845-359-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002477-1363AM0700X
NJMP200259363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical